nkhani

Mphamvu ya placebo imatanthawuza kumverera kwa thanzi labwino m'thupi la munthu chifukwa cha ziyembekezo zabwino pamene akulandira chithandizo chosagwira ntchito, pamene anti-placebo effect ndi kuchepa kwa mphamvu zomwe zimadza chifukwa cha ziyembekezo zoipa pamene mukulandira mankhwala osokoneza bongo, kapena kuchitika kwa zotsatira zoyipa chifukwa cha zoyembekeza zoipa mukalandira placebo, zomwe zingayambitse kuwonongeka kwa chikhalidwecho. Nthawi zambiri amapezeka muzachipatala komanso kafukufuku, ndipo amatha kukhudza magwiridwe antchito ndi zotsatira za odwala.

Mphamvu ya placebo ndi anti placebo effect ndi zotsatira zobwera ndi ziyembekezo zabwino ndi zoipa za odwala paumoyo wawo, motsatana. Zotsatirazi zimatha kuchitika m'malo osiyanasiyana azachipatala, kuphatikiza kugwiritsa ntchito mankhwala osokoneza bongo kapena placebo pochiza kuchipatala kapena mayesero, kulandira chilolezo chodziwitsidwa, kupereka zidziwitso zokhudzana ndi zamankhwala, komanso kuchita ntchito zolimbikitsa thanzi la anthu. Zotsatira za placebo zimabweretsa zotulukapo zabwino, pomwe anti placebo effect imatsogolera ku zotsatira zoyipa komanso zowopsa.

Kusiyanasiyana kwamayankhidwe amankhwala ndi zizindikiro zowonetsera pakati pa odwala osiyanasiyana kumatha kukhala chifukwa cha zotsatira za placebo ndi anti placebo. Muzochita zachipatala, mafupipafupi ndi mphamvu ya zotsatira za placebo zimakhala zovuta kudziwa, pamene pansi pa zoyesera, mafupipafupi ndi mphamvu ya zotsatira za placebo ndizochuluka. Mwachitsanzo, m'mayesero ambiri achipatala akhungu awiri ochizira ululu kapena matenda a maganizo, kuyankha kwa placebo kumafanana ndi mankhwala osokoneza bongo, ndipo mpaka 19% ya akuluakulu ndi 26% mwa okalamba omwe adalandira placebo adanena zotsatira zake. Kuphatikiza apo, m'mayesero azachipatala, mpaka 1/4 mwa odwala omwe adalandira placebo adasiya kumwa mankhwalawa chifukwa cha zovuta zake, zomwe zikuwonetsa kuti anti placebo effect ingayambitse kusiya kugwiritsa ntchito mankhwala kapena kusatsatira bwino.

Njira za neurobiological za placebo ndi anti placebo zotsatira
Zotsatira za placebo zasonyezedwa kuti zimagwirizanitsidwa ndi kutulutsidwa kwa zinthu zambiri, monga opioid osadziwika, cannabinoids, dopamine, oxytocin, ndi vasopressin. Zochita za chinthu chilichonse zimayang'ana pa dongosolo lomwe mukufuna (mwachitsanzo, kupweteka, kuyenda, kapena chitetezo chamthupi) ndi matenda (monga nyamakazi kapena matenda a Parkinson). Mwachitsanzo, kutulutsidwa kwa dopamine kumakhudzidwa ndi zotsatira za placebo pochiza matenda a Parkinson, koma osati mu zotsatira za placebo pochiza kupweteka kosalekeza kapena koopsa.

Kuwonjezeka kwa ululu wobwera chifukwa cha malingaliro apakamwa poyesera (anti placebo effect) kwasonyezedwa kuti ndi mkhalapakati wa neuropeptide cholecystokinin ndipo akhoza kutsekedwa ndi proglutamide (yomwe ndi mtundu A ndi mtundu wa B receptor antagonist wa cholecystokinin). Mwa anthu athanzi, hyperalgesia yoyambitsidwa ndi chilankhulochi imalumikizidwa ndi kuchuluka kwa ntchito ya hypothalamic pituitary adrenal axis. Mankhwala a benzodiazepine, diazepam, amatha kusokoneza hyperalgesia ndi hyperactivity ya hypothalamic pituitary adrenal axis, kutanthauza kuti nkhawa imakhudzidwa ndi zotsatira za anti placebo. Komabe, alanine amatha kuletsa hyperalgesia, koma sangathe kuletsa kuwonjezereka kwa hypothalamic pituitary adrenal axis, kutanthauza kuti cholecystokinin system imakhudzidwa ndi hyperalgesia gawo la anti placebo effect, koma osati mu gawo la nkhawa. Mphamvu ya majini pa placebo ndi anti placebo zotsatira zimagwirizanitsidwa ndi haplotypes of single nucleotide polymorphisms mu dopamine, opioid, ndi majini amtundu wa cannabinoid.

Meta-analysis ya meta-analysis ya 20 yogwira ntchito ya neuroimaging yokhudzana ndi odwala 603 omwe ali ndi thanzi labwino adawonetsa kuti zotsatira za placebo zomwe zimagwirizanitsidwa ndi ululu zimangokhudza pang'ono pa mawonetseredwe okhudzana ndi zowawa (zomwe zimatchedwa siginecha za ululu wa neurogenic). Zotsatira za placebo zitha kukhala ndi gawo pamagulu angapo a maukonde aubongo, omwe amalimbikitsa kutengeka ndi kukhudzidwa kwawo pazochitika zowawa zambiri. Kujambula kwaubongo ndi msana kumasonyeza kuti anti placebo effect imabweretsa kuwonjezeka kwa mauthenga opweteka kuchokera ku msana kupita ku ubongo. Poyesera kuyesa kuyankha kwa otenga nawo gawo pamafuta a placebo, zononazi zidafotokozedwa kuti zimapweteka ndipo zimatchedwa mtengo wapamwamba kapena wotsika. Zotsatirazo zinasonyeza kuti madera opatsirana ululu mu ubongo ndi msana anatsegulidwa pamene anthu ankayembekezera kumva ululu wopweteka kwambiri atalandira chithandizo ndi zonona zamtengo wapatali. Mofananamo, zoyesera zina zayesa ululu wopangidwa ndi kutentha komwe kungathe kumasulidwa ndi mankhwala amphamvu a opioid remifentanil; Mwa omwe adatenga nawo gawo omwe amakhulupirira kuti remifentanil idathetsedwa, hippocampus idatsegulidwa, ndipo anti placebo effect idalepheretsa mphamvu ya mankhwalawa, kutanthauza kuti kupsinjika ndi kukumbukira zidakhudzidwa ndi izi.

Zoyembekeza, Malangizo a Zinenero, ndi Zotsatira za Framework
Zochitika za mamolekyulu ndi neural network zosinthika zomwe zimachitika pa placebo ndi anti placebo zimayanjanitsidwa ndi zomwe amayembekezera kapena zodziwiratu zam'tsogolo. Ngati chiyembekezo chitha kukwaniritsidwa, chimatchedwa kuyembekezera; Zoyembekeza zimatha kuyesedwa ndikukhudzidwa ndi kusintha kwa malingaliro ndi kuzindikira. Zoyembekeza zikhoza kupangidwa m'njira zosiyanasiyana, kuphatikizapo zochitika zam'mbuyo za zotsatira za mankhwala ndi zotsatira zake (monga zotsatira za analgesic pambuyo pa mankhwala), malangizo apakamwa (monga kudziwitsidwa kuti mankhwala enaake amatha kuchepetsa ululu), kapena zochitika zamagulu (monga kuyang'ana mwachindunji mpumulo wa zizindikiro mwa ena mutamwa mankhwala omwewo). Komabe, zoyembekeza zina ndi zotsatira za placebo ndi anti placebo sizingachitike. Mwachitsanzo, titha kuyambitsa mayankho a immunosuppressive mwa odwala omwe akusinthidwa impso. Njira yotsimikizira ndiyo kugwiritsa ntchito zolimbikitsa zandale zomwe zidaphatikizidwa kale ndi ma immunosuppressants kwa odwala. Kugwiritsiridwa ntchito kwa kusalowerera ndale kokha kumachepetsanso kuchuluka kwa maselo a T.

Muzochitika zachipatala, ziyembekezo zimakhudzidwa ndi momwe mankhwala amafotokozedwera kapena "ndondomeko" yogwiritsidwa ntchito. Pambuyo pa opaleshoni, poyerekeza ndi kayendetsedwe ka masks komwe wodwalayo sakudziwa nthawi yoyendetsera, ngati chithandizo chomwe mudzalandira pamene mukupereka morphine chimasonyeza kuti chikhoza kuthetsa ululu, chidzabweretsa phindu lalikulu. Kufunsiridwa kwachindunji kwa zotsatirapo kungathenso kudzikwaniritsa. Kafukufuku wina anaphatikizapo odwala omwe amathandizidwa ndi beta blocker atenolol chifukwa cha matenda a mtima ndi matenda oopsa, ndipo zotsatira zake zinasonyeza kuti zochitika zokhudzana ndi kugonana ndi kusokonezeka kwa erectile zinali 31% mwa odwala omwe adadziwitsidwa mwadala za zotsatirapo, pamene zochitikazo zinali 16% mwa odwala omwe sanadziwitsidwe za zotsatirapo. Mofananamo, pakati pa odwala omwe adatenga finasteride chifukwa cha kukula kwa prostate, 43% ya odwala omwe adadziwitsidwa momveka bwino za zotsatira za kugonana adakumana ndi mavuto, pamene pakati pa odwala omwe sanadziwitsidwe za zotsatira za kugonana, chiwerengerochi chinali 15%. Kafukufuku wina adaphatikizapo odwala mphumu omwe adakoka saline ya nebulize ndipo adadziwitsidwa kuti akukoka ma allergen. Zotsatirazo zinasonyeza kuti pafupifupi theka la odwalawo anali ndi vuto la kupuma, kuwonjezeka kwa mpweya, komanso kuchepa kwa mapapu. Pakati pa odwala mphumu omwe adakoka ma bronchoconstrictors, omwe adadziwitsidwa za bronchoconstrictor adakumana ndi vuto lalikulu la kupuma komanso kusayenda bwino kwa mpweya kuposa omwe adauzidwa za bronchodilator.

Kuphatikiza apo, zoyembekeza zomwe zimayambitsidwa ndi chilankhulo zimatha kuyambitsa zizindikiro zina monga kupweteka, kuyabwa, ndi nseru. Pambuyo pa chilankhulo cha chinenero, zokopa zokhudzana ndi kupweteka kwapang'onopang'ono zingawoneke ngati zowawa kwambiri, pamene tactile stimuli ikhoza kuwoneka ngati ululu. Kuphatikiza pa kukopa kapena kukulitsa zizindikiro, ziyembekezo zoipa zingathenso kuchepetsa mphamvu ya mankhwala omwe akugwira ntchito. Ngati chidziwitso chonyenga chakuti mankhwala adzakulitsa m'malo mochepetsa ululu amaperekedwa kwa odwala, zotsatira za analgesics m'deralo zikhoza kutsekedwa. Ngati 5-hydroxytryptamine receptor agonist rizitriptan imalembedwa molakwika ngati placebo, ikhoza kuchepetsa mphamvu yake pochiza matenda a migraine; Mofananamo, ziyembekezo zoipa zingathenso kuchepetsa zotsatira za analgesic za mankhwala opioid pa ululu woyesera.

Njira zophunzirira mu zotsatira za placebo ndi anti placebo
Kuphunzira komanso kukhazikika kwakale kumakhudzidwa ndi zotsatira za placebo ndi anti placebo. M'zochitika zambiri zachipatala, kutengeka kosalowerera ndale komwe kumagwirizanitsidwa ndi zotsatira zopindulitsa kapena zovulaza za mankhwala kudzera mu chikhalidwe chachikale kumatha kubweretsa ubwino kapena zotsatira zake popanda kugwiritsa ntchito mankhwala osokoneza bongo m'tsogolomu.

Mwachitsanzo, ngati zizindikiro za chilengedwe kapena zokometsera zimaphatikizidwa mobwerezabwereza ndi morphine, zizindikiro zomwezo zomwe zimagwiritsidwa ntchito ndi placebo m'malo mwa morphine zimathabe kutulutsa mphamvu zochepetsera ululu. Odwala a psoriasis omwe adalandira kuchepetsedwa kwa mlingo wa glucocorticoids ndi placebo (omwe amatchedwa kuti mlingo wotambasula wa placebo), kuyambiranso kwa psoriasis kunali kofanana ndi kwa odwala omwe akulandira chithandizo chonse cha glucocorticoid. Mu gulu lolamulira la odwala omwe adalandira njira yochepetsera ya corticosteroid koma sanalandire placebo pakapita nthawi, chiwerengero chobwereza chinali chokwera katatu kuposa gulu la mankhwala a placebo. Zotsatira zofananazo zakhala zikunenedwa pochiza kusowa tulo kosatha komanso kugwiritsa ntchito ma amphetamines kwa ana omwe ali ndi vuto losazindikira.

Zomwe zidachitika m'mbuyomu komanso njira zophunzirira zimayendetsanso anti placebo effect. Pakati pa amayi omwe amalandira mankhwala a chemotherapy chifukwa cha khansa ya m'mawere, 30% a iwo adzakhala akuyembekezera nseru atakumana ndi zochitika zachilengedwe (monga kubwera ku chipatala, kukumana ndi ogwira ntchito zachipatala, kapena kulowa m'chipinda chofanana ndi chipinda cholowetseramo) chomwe sichinalowererepo chisanachitike koma adagwirizanitsidwa ndi kulowetsedwa. Ana obadwa kumene omwe adutsa mobwerezabwereza venipuncture nthawi yomweyo amawonetsa kulira ndi ululu panthawi yomwe amatsuka khungu lawo asanagone. Kuwonetsa ma allergen m'mitsuko yosindikizidwa kwa odwala mphumu kungayambitse mphumu. Ngati madzi omwe ali ndi fungo linalake koma opanda zotsatira zopindulitsa zamoyo adaphatikizidwa ndi mankhwala omwe ali ndi zotsatira zoyipa (monga tricyclic antidepressants) kale, kugwiritsa ntchito madziwo ndi placebo kungayambitsenso mavuto. Ngati zizindikiro zowoneka (monga kuwala ndi zithunzi) zinagwirizanitsidwa kale ndi zowawa zoyesera, ndiye kuti kugwiritsa ntchito zowonetserako zokhazokha kungayambitsenso ululu m'tsogolomu.

Kudziwa zomwe ena akumana nazo kungayambitsenso zotsatira za placebo ndi anti placebo. Kuwona mpumulo wa ululu kuchokera kwa ena kungayambitsenso mphamvu ya placebo, yomwe imakhala yofanana ndi mphamvu yochepetsera ululu yomwe munthu amalandira asanalandire chithandizo. Pali umboni woyesera wosonyeza kuti chikhalidwe cha anthu ndi ziwonetsero zingayambitse zotsatirapo. Mwachitsanzo, ngati otenga nawo mbali akuwona ena akufotokoza za zotsatira za placebo, afotokoze ululu atagwiritsa ntchito mafuta osagwira ntchito, kapena kupuma mpweya wamkati womwe umafotokozedwa kuti "ukhoza kukhala poizoni," zingayambitsenso zotsatira za anthu omwe ali ndi placebo, mafuta osagwira ntchito, kapena mpweya wamkati.

Malipoti apawailesi yakanema komanso malipoti osakhala akatswiri atolankhani, zidziwitso zopezeka pa intaneti, komanso kulumikizana mwachindunji ndi anthu ena omwe ali ndi zizindikiro zonse zitha kulimbikitsa machitidwe odana ndi placebo. Mwachitsanzo, kuchuluka kwa lipoti la zoyipa za ma statins kumalumikizidwa ndi kuchulukira kwa lipoti loyipa la ma statins. Pali chitsanzo chowoneka bwino kwambiri pamene chiwerengero cha zochitika zovuta zomwe zinanenedwa zinawonjezeka ndi nthawi za 2000 pambuyo pa mauthenga oipa ndi mauthenga a pawailesi yakanema adawonetsa kusintha kovulaza kwa mankhwala a chithokomiro, ndipo kumangophatikizapo zizindikiro zenizeni zomwe zatchulidwa mu malipoti oipa. Momwemonso, pambuyo pokwezedwa pagulu kupangitsa anthu ammudzi kukhulupirira molakwika kuti ali ndi zinthu zapoizoni kapena zinyalala zowopsa, kuchuluka kwa zizindikiro zomwe zimabwera chifukwa cha kuwonekera kumawonjezeka.

Zotsatira za placebo ndi anti placebo zotsatira pa kafukufuku ndi machitidwe azachipatala
Zingakhale zothandiza kudziwa yemwe ali ndi vuto la placebo ndi anti placebo kumayambiriro kwa chithandizo. Zina zokhudzana ndi mayankhowa zikudziwika pano, koma kafukufuku wamtsogolo angapereke umboni wabwinoko wazinthuzi. Chiyembekezo ndi kutengeka kwa malingaliro sizikuwoneka kuti zikugwirizana kwambiri ndi kuyankha kwa placebo. Pali umboni wosonyeza kuti anti placebo effect imatha kuchitika mwa odwala omwe ali ndi nkhawa kwambiri, omwe adakumanapo ndi zizindikiro za zifukwa zosadziwika zachipatala, kapena omwe ali ndi vuto lalikulu la maganizo pakati pa omwe amamwa mankhwala osokoneza bongo. Pakali pano palibe umboni womveka bwino wokhudza udindo wa jenda mu placebo kapena anti placebo zotsatira. Kujambula, kuopsa kwa majini ambiri, maphunziro a ma genome-wide association, ndi maphunziro amapasa angathandize kufotokozera momwe ubongo ndi majini zimakhudzira kusintha kwachilengedwe komwe kumakhala ngati maziko a zotsatira za placebo ndi anti placebo.

Kuyanjana pakati pa odwala ndi madotolo azachipatala kungakhudze kuthekera kwa zotsatira za placebo ndi zotsatirapo zomwe zanenedwa pambuyo polandira placebo ndi mankhwala ogwira ntchito. Chikhulupiriro cha odwala kwa madokotala achipatala ndi ubale wawo wabwino, komanso kulankhulana moona mtima pakati pa odwala ndi madokotala, zatsimikiziridwa kuti zimachepetsa zizindikiro. Chotero, odwala amene amakhulupirira kuti madokotala amachitira chifundo ndipo amafotokoza zizindikiro za chimfine amakhala ocheperapo ndi aafupi m’nthaŵi ya awo amene amakhulupirira kuti madokotala alibe chifundo; Odwala omwe amakhulupirira kuti madokotala ndi achifundo amawonanso kuchepa kwa zizindikiro za kutupa, monga interleukin-8 ndi neutrophil count. Zoyembekeza zabwino za madotolo azachipatala zimathandiziranso gawo la placebo. Kafukufuku wochepa poyerekeza ndi mankhwala oletsa ululu ndi mankhwala a placebo pambuyo pochotsa dzino anasonyeza kuti madokotala ankadziwa kuti odwala omwe amalandira mankhwala ochepetsa ululu amagwirizanitsidwa ndi kupweteka kwakukulu.

Ngati tikufuna kugwiritsa ntchito zotsatira za placebo kuti tipititse patsogolo chithandizo chamankhwala popanda kutsatira njira yachibadwidwe, njira imodzi ndiyo kufotokoza chithandizocho mwanjira yeniyeni koma yabwino. Kukweza ziyembekezo za chithandizo chamankhwala kwawonetsedwa kuti kumathandizira kuyankha kwa odwala ku morphine, diazepam, kukondoweza kwakuya kwaubongo, kuwongolera m'mitsempha ya remifentanil, kuyang'anira komweko kwa lidocaine, chithandizo chothandizira komanso chophatikizika (monga acupuncture), komanso ngakhale opaleshoni.

Kufufuza zoyembekeza za odwala ndi sitepe yoyamba yophatikizira ziyembekezo izi muzochita zachipatala. Poyang'ana zotsatira zachipatala zomwe zikuyembekezeka, odwala angapemphedwe kuti agwiritse ntchito sikelo ya 0 (palibe phindu) mpaka 100 (kupindula kwakukulu komwe angaganizire) kuti awone zomwe akuyembekezera kuti athandizidwe. Kuthandiza odwala kumvetsetsa zomwe akuyembekezera pa opaleshoni yamtima yosankha kumachepetsa zotsatira za kulemala pa miyezi ya 6 pambuyo pa opaleshoni; Kupereka chitsogozo cha njira zothanirana ndi odwala musanayambe opaleshoni ya m'mimba kunachepetsa kwambiri ululu wapambuyo pa opaleshoni ndi mlingo wa mankhwala ochititsa dzanzi (ndi 50%). Njira zogwiritsira ntchito zotsatira za chimangozi zikuphatikiza osati kufotokoza kuyenera kwa chithandizo kwa odwala, komanso kufotokoza kuchuluka kwa odwala omwe amapindula nawo. Mwachitsanzo, kugogomezera kugwira ntchito kwa mankhwala kwa odwala kungachepetse kufunika kwa mankhwala ochepetsa ululu pambuyo pa opaleshoni kuti odwala azitha kudziletsa.

M'zachipatala, pakhoza kukhala njira zina zogwiritsira ntchito mphamvu ya placebo. Kafukufuku wina amathandizira mphamvu ya njira ya "open label placebo", yomwe imaphatikizapo kuperekera placebo pamodzi ndi mankhwala omwe akugwira ntchito komanso kudziwitsa odwala moona mtima kuti kuwonjezera mankhwala a placebo kwatsimikiziridwa kuti kumawonjezera phindu la mankhwala ogwiritsidwa ntchito, potero kumawonjezera mphamvu yake. Kuonjezera apo, ndizotheka kukhalabe ndi mphamvu ya mankhwala ogwiritsidwa ntchito pogwiritsa ntchito chikhalidwe pamene mukuchepetsa pang'onopang'ono mlingo. Njira yeniyeni yogwirira ntchito ndikuphatikiza mankhwalawo ndi zomverera, zomwe zimakhala zothandiza kwambiri pamankhwala oopsa kapena osokoneza bongo.

M'malo mwake, zidziwitso zodetsa nkhawa, zikhulupiriro zolakwika, ziyembekezo zokayikitsa, zomwe zidachitikapo kale, zambiri zokhudzana ndi chikhalidwe cha anthu, komanso malo ochiritsira zitha kubweretsa zotsatirapo zoyipa ndikuchepetsa mapindu a chithandizo chazizindikiro ndi kupumula. Zotsatira zosadziwika za mankhwala omwe akugwira ntchito (nthawi, mosiyanasiyana, mlingo wodziyimira pawokha, komanso kusadalirika kwa kubalana) ndizofala. Zotsatirazi zingayambitse kusamalidwa bwino kwa odwala ku ndondomeko ya chithandizo (kapena discontinuation plan) yoperekedwa ndi dokotala, kuwafuna kuti asinthe mankhwala ena kapena kuwonjezera mankhwala ena kuti athetse zotsatirazi. Ngakhale tikufunikira kafukufuku wambiri kuti tidziwe mgwirizano womveka bwino pakati pa awiriwa, zotsatira zosadziwika bwinozi zikhoza kuyambitsidwa ndi anti placebo effect.

Zingakhale zothandiza kufotokoza zotsatira zake kwa wodwalayo komanso kuwonetsa ubwino wake. Zingakhalenso zothandiza kufotokoza zotsatira zake m'njira yothandizira osati mwachinyengo. Mwachitsanzo, kufotokozera odwala kuchuluka kwa odwala opanda zotsatirapo, osati kuchuluka kwa odwala omwe ali ndi zotsatirapo, kungachepetse zotsatira za zotsatirazi.

Madokotala ali ndi udindo wopeza chilolezo chodziwika bwino kuchokera kwa odwala asanagwiritse ntchito chithandizo. Monga gawo la chilolezo chodziwitsidwa, madokotala amafunika kupereka chidziwitso chokwanira kuti athandize odwala kupanga zisankho zomveka. Madokotala ayenera kufotokoza momveka bwino komanso molondola zotsatira zonse zomwe zingakhale zoopsa komanso zoopsa zachipatala, ndikudziwitsa odwala kuti zotsatira zake zonse ziyenera kufotokozedwa. Komabe, kutchula zotsatira zoyipa komanso zosafunikira kwenikweni zomwe sizifuna chithandizo chamankhwala chimodzi ndi chimodzi kumawonjezera mwayi woti zichitike, zomwe zimabweretsa vuto kwa madokotala. Njira imodzi yothanirana ndi vutoli ndikudziwitsa odwala za anti placebo effect ndikuwafunsa ngati ali okonzeka kuphunzira za zoyipa zomwe zimachitika chifukwa cha chithandizocho atadziwa za izi. Njira imeneyi imatchedwa "contextualized informal consent" ndi "authorized consideration".

Kufufuza nkhanizi ndi odwala kungakhale kothandiza chifukwa zikhulupiriro zolakwika, ziyembekezo zodetsa nkhawa, komanso zokumana nazo zoyipa pakugwiritsa ntchito mankhwala am'mbuyomu zimatha kuyambitsa anti placebo effect. Ndi zotsatira zotani zokhumudwitsa kapena zowopsa zomwe adakumana nazo m'mbuyomu? Ndi zotsatira zotani zomwe akukhudzidwa nazo? Ngati panopa akuvutika ndi zotsatira zoyipa, akuganiza kuti zotsatira zake zimakhala zotani? Kodi amayembekezera kuti zotsatirapo zake zidzaipiraipira pakapita nthawi? Mayankho operekedwa ndi odwala angathandize madokotala kuchepetsa nkhawa zawo za zotsatirapo, kupangitsa chithandizo kukhala chololera. Madokotala angatsimikizire odwala kuti ngakhale kuti zotsatira zake zingakhale zovuta, zimakhala zopanda vuto komanso sizowopsa mwamankhwala, zomwe zingathandize kuchepetsa nkhawa yomwe imayambitsa zotsatirapo. M'malo mwake, ngati kuyanjana pakati pa odwala ndi madokotala achipatala sikungathe kuchepetsa nkhawa zawo, kapena kukulitsa, zidzakulitsa zotsatira zake. Kuwunika koyenera kwa kafukufuku woyesera ndi zamankhwala kukuwonetsa kuti machitidwe oyipa osalankhula komanso njira zoyankhulirana zopanda chidwi (monga kuyankhula mwachifundo, kusayang'ana maso ndi odwala, kulankhula monyanyira, komanso kusamwetulira pankhope) kumatha kulimbikitsa anti placebo effect, kuchepetsa kulekerera kwa odwala ku ululu, ndi kuchepetsa zotsatira za placebo. Zotsatira zake zomwe zimaganiziridwa nthawi zambiri zimakhala zizindikiro zomwe poyamba zinkanyalanyazidwa kapena kunyalanyazidwa, koma tsopano zimatchedwa mankhwala. Kuwongolera malingaliro olakwikawa kungapangitse mankhwalawa kukhala olekerera.

Zotsatira zoyipa zomwe odwala amafotokozera zitha kuwoneka mwachisawawa komanso mobisa, kuwonetsa kukayikira, kusungika, kapena nkhawa zamankhwala, dongosolo lamankhwala, kapena luso laukadaulo la dokotala. Poyerekeza ndi kufotokoza kukayikira mwachindunji kwa madokotala azachipatala, zotsatira zake ndizosachititsa manyazi komanso chifukwa chovomerezeka chosiya kumwa mankhwala. Pazifukwa izi, kulongosola momveka bwino ndi kukambirana momasuka za nkhawa za wodwalayo kungathandize kupewa mikhalidwe yosiya kapena kusamvera.

Kafukufuku wokhudzana ndi zotsatira za placebo ndi anti placebo ali ndi tanthauzo pakupanga ndi kukhazikitsa mayesero achipatala, komanso kutanthauzira zotsatira. Choyamba, ngati n'kotheka, mayesero a zachipatala ayenera kuphatikizapo magulu othandizira kuti afotokoze zinthu zosokoneza zokhudzana ndi placebo ndi anti-placebo zotsatira, monga kuchepetsa zizindikiro. Kachiwiri, mapangidwe a nthawi yayitali a mayeserowa adzakhudza zochitika za kuyankha kwa placebo, makamaka mu mapangidwe a crossover, monga kwa otenga nawo mbali omwe adalandira mankhwala ogwiritsidwa ntchito poyamba, zochitika zabwino zam'mbuyo zingabweretse ziyembekezo, pamene otenga nawo mbali omwe adalandira placebo poyamba sanatero. Popeza kudziwitsa odwala za mapindu enieni ndi zotsatira za mankhwala kungawonjezere kuchuluka kwa zopindulitsa izi ndi zotsatira zake, ndi bwino kusunga kugwirizana kwa ubwino ndi zotsatira za zotsatira zomwe zimaperekedwa panthawi ya chilolezo chodziwitsidwa pamayesero ophunzirira mankhwala enaake. Pakuwunika kwa meta komwe chidziwitso chimalephera kufikira kusasinthika, zotsatira zake ziyenera kutanthauziridwa mosamala. Ndibwino kuti ochita kafukufuku omwe amasonkhanitsa deta pa zotsatira zoyipa asadziwe gulu lachipatala komanso momwe zilili ndi zotsatira zake. Posonkhanitsa deta yokhudzana ndi zotsatira zake, mndandanda wa zizindikiro zokhazikika ndi bwino kusiyana ndi kafukufuku wotseguka.